Bipolar Me

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My Two Diagnoses

March 9, 2025

For all my childhood, I assumed I had depression, though I didn’t know that it was a psychiatric diagnosis. I was always a moody child, given to bursting into tears at the slightest provocation.

My first really major depressive meltdown came when I was humiliated by another child at a birthday party. I ran home, curled up in a beanbag chair, and sobbed for days. The only thing that snapped me out of it was the fact that my mother was being hurt by it too. She was crying too and had no idea what to do about my emotional implosion. At that point, I went down the street and yelled at the girl who had instigated the incident. (I suppose this could have been bipolar rage. I was pretty incoherent.)

I still remember this event as clearly as when it happened.

Another time, some friends were making fun of the way I laughed. Without saying a word, I got in my car and drove home, removing myself from what was distressing me. They followed me home and apologized. Then, I practiced laughing until I came up with something more acceptable. I think I accomplished it, though who really knows?

In my college years, I spiraled further. I was prescribed benzos for a TMJ problem, and I was in such a bad emotional place that I supplemented them with wine. There was some risky sexual behavior, too. It was the first time I recognized that I had a hypomanic episode. After I got out of the situation, I stopped relying on the benzos. (Actually, I had first experienced benzos in my junior high school years, when they were prescribed for an uncontrollable tic.)

Eventually, I went into therapy where I was diagnosed, as I expected, with depression. I continued that way for years, being prescribed various medications but still having symptoms.

Finally, I went to a new psychiatrist who, after some time, said he thought I had bipolar disorder. Eventually, we found a drug regimen that worked to alleviate my symptoms to an acceptable point.

I was still having symptoms, though, before the right cocktail was achieved. I was unable to work, get out of bed, or do much of anything, unhappy all the time. I applied for disability—and didn’t get it. When I got my file from Dr. R., I saw that my diagnosis was actually both bipolar and anxiety.

That threw me for a while. But looking backward and forward, I realize that he was right. I had anxiety episodes when I was a kid, usually regarding finding and keeping friends. I was terrified when my high school counselor suggested therapy. (I declined.) I panicked when it looked like I would have to go to community college instead of a four-year school, which I had always assumed was in my future. When I did get to that college, I had a mixture of the depression and anxiety, and took a year off to work and reset my brain.

Now, years later, my bipolar disorder is largely under control. But the anxiety haunts me to this day. I am anxious about family finances (which I am in charge of). Many nights my brain won’t shut up and I can’t sleep. (Sometimes it won’t shut up about the unfortunate episodes in my past.) I had massive anxiety recently regarding a trip to Florida.

So, I think Dr. R. was right when he diagnosed me with bipolar and anxiety. One has been tamed, but the other lingers. I am now working with Dr. G. to help me alleviate the anxiety without letting the bipolar kick up again. It’s a delicate balance.

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Advances in Schizophrenia Treatment

March 2, 2025

Schizophrenia is one of the most problematic and least tractable of the Serious Mental Illnesses (SMI). Recently, though, there have been advancements in treatment in terms of medications, therapy, and even virtual reality. Let’s take a look at what’s happening.

Medications

Medications have been the traditional way to treat schizophrenia. In the 1970s, there were drugs such as fluphenazine, chlorpromazine, and clozapine, the first atypical antipsychotic. Among the drawbacks were movement disorders such as akathisia, Parkinsonism, and tardive dyskinesia. Many people stopped taking them because they couldn’t handle the side effects. They were also noted for their sedative effects, and were primarily effective for positive symptoms such as hallucinations and delusions rather than negative ones such as flat affect. But medications weren’t the only possibilities. There were also insulin comas, the much-maligned ECT, and the thoroughly abhorrent frontal lobotomy.

In recent years, there have been advancements in medications for schizophrenia. In 2024, for example, the FDA approved a drug called Cobenfy. It combines two other medications, xanomeline and trospium chloride. Apparently, it reduces psychosis and delusions in schizophrenia without many of the side effects like unwanted movements and weight gain. On the other hand, xanomeline has its own side effects, including diarrhea, nausea, vomiting, and increased heart rate and blood pressure, so there’s that. (It’s also used to decrease symptoms in Alzheimer’s patients. Another new drug, KarXT, which is still experimental, is another combination drug that shows promise. Like Cobenfy, it’s supposed to reduce both psychosis and side effects.

Therapies

In the 70’s, effective therapies for schizophrenia were not really available. Psychoanalysis and family therapy were tried, largely to no avail. (The famous book I Never Promised You a Rose Garden epitomized the psychoanalytical approach, misleading many.) They missed the fact that schizophrenia is a serious brain illness, not really amenable to talk therapies.

Still, some psychosocial therapies are now in use. Cognitive remediation is said to show benefits for social and vocational functioning. Another method, called “Errorless learning,” which focuses on rehabilitation, also targets social and work skills. And Integrated psychological therapy is likewise suggested for improving social skills. None of them applies to the more severe cases of schizophrenia, but can be helpful for those who experience milder symptoms or are fairly well controlled by medication.

Virtual Reality

Virtual or augmented reality devices have also been used to help schizophrenic patients learn coping skills. In particular, they are said to be helpful in transferring these skills from a virtual environment to daily life. It’s also been suggested that such alternative realities can be used for research to assess patients’ reactions to specific environments. Computer-animated humanoid agents are also being investigated for use in encouraging medication compliance. An analysis by Chivilgina, Elger, and Jotterand says that these technologies “pose more questions than answers,” however, and to “to establish safe environments, further examination is needed.”

Treatments for Tardive Dyskinesia

You can’t talk about treatments for schizophrenia without talking about treatments for TD. Along with sedation, it’s one of the side effects that frequently causes patients to stop taking their medication. It’s also one of the more disabling side effects, as TD movements can vary from minor yet noticeable to extreme and debilitating. Unfortunately, many of the treatments for TD have a significant side effects: abnormal movements. So, you get a drug that is supposed to treat abnormal movements—and the result can be abnormal movements.

Guidelines from the American Academy of Neurology say that drug treatments for TD include clonazepam, valbenazine (Ingrezza), deutetrabenazine (Austedo), and clonazepam. Among other treatments for TD, clozapine, vitamin E, levodopa, benzodiazepines, botulinum toxin, reserpine, tetrabenazine, propranolol, and gingko biloba have been tried, as well as less common substances used in Chinese medicine. And there are off label uses of drugs usually prescribed for other conditions. For particularly intractable cases, deep brain stimulation can be tried. If this sounds kind of hit or miss, it is. I would hate to be a patient who had to try each of these therapies in hopes of finding one that works for me.

Still, the outlook for schizophrenic patients seems to be improving, and increasingly researched. As with most psychiatric medications, the trick is finding treatments whose side effects aren’t worse than the disorder they’re prescribed for.

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Is a Keto Diet Good for Bipolar?

February 23, 2025

I’m sure you’ve read the ads and articles that say apple cider vinegar is good for anything that ails you. There are also supposed “superfoods” that activate your immune system and ward off diseases. Then there are diets—Mediterranean, paleo, Atkins, gluten-free, intermittent fasting, vegetarian, vegan, low-carb, sugar-free, South Beach, carnivore, and more. Each of them is supposed to be good for your body or some part of it. And that may be true. I can’t say that one or another is good for everyone.

But what about people with bipolar disorder? A quick Google tells me that Omega 3, folic acid, probiotics, magnesium, walnuts, whole grains, CoQ10, tryptophan, Vitamin D, Vitamin B12, Vitamin C, and Acetylcysteine (which loosens thick mucus) are recommended nutrients for us.

But the diet (or eating plan) I’ve heard the most about in relation to mental disorders is the keto diet.

First, let’s look at what the keto diet actually is. It involves consuming a very low amount of carbohydrates and replacing them with fat to help your body burn fat for energy. That means you should avoid sugary foods, grains and starches, most fruit, beans and legumes, root vegetables and tubers, low-fat or diet products, unhealthy fats, alcohol, and sugar-free diet foods.

What’s left? Good fats like avocados and EVOO, as well as meat, fatty fish, eggs, butter and cream, cheese, nuts, seeds, low-carb veggies, and herbs and spices. This diet is supposed to be good for people with neurological disorders like epilepsy, heart disease, cancer, Alzheimer’s, Parkinson’s, and traumatic brain injuries.

Lately, however, the keto diet has been investigated as being good for mood disorders including depression and bipolar disorder.

Healthline reports that, based on the idea that a keto diet is good for those with epilepsy and that anti-seizure medications are often used to treat bipolar disorder, “during a depressed or manic episode, energy production slows in the brain. Eating a ketogenic diet can increase energy in the brain.” Also, the keto diet lowers the amount of sodium in the cells, which is partially the way lithium and other mood stabilizers work. They note, however, that very little research has been done on this theory.

However, UCLA Health is planning such a study. They note that, while most previous studies have focused on adults, the new study will include youth and young adults who have bipolar disorder. Participants will go on a ketogenic diet for 16 weeks while continuing their usual medications. Dieticians, psychologists, and psychiatrists are involved and there will be daily blood tests measuring metabolic indicators. In the future, the researchers say, they will compare the keto diet with another meal plan such as the Mediterranean diet.

Stanford has conducted a pilot study on the ketogenic diet. They say that, in addition to improving metabolic conditions, the diet improved patients’ psychiatric conditions and metabolic health while they continued with their medications. The results, published in Psychiatry Research, said that dietary interventions such as the keto diet may assist in treating mental illness.

A French study that was reported in Psychology Today focused on people with major depressive disorder, bipolar disorder, or schizophrenia. Symptoms improved in all the participants who followed the diet for more than two weeks. Almost two-thirds were able to reduce their medication.

There seem to be drawbacks to a keto diet, however. Healthline also notes that the diet can lead to shortages of vitamins B, C, and D, as well as calcium, magnesium, and iron. There can also be digestive difficulties such as nausea, vomiting, and constipation. They recommend supervision by a physician. Other people report mood swings related to the keto diet.

The advice from WebMD is that there is “insufficient evidence” to recommend the diet as beneficial for mood disorders. They don’t recommend it as a treatment option. As with any diet plan, consulting your doctor first is a good idea.

As for me, I have my doubts about currently (or formerly) trendy diets and superfoods, though the Mediterranean diet sounds good and balanced to me. Am I likely to try the keto diet? Well, I would miss bread, fruit, potatoes, and sugar-free products. Stocking up on meat, fish, avocados, cheese, herbs, and spices I could manage rather easily. But until more results are in from the various studies, I probably won’t change the way I eat very much.

As always, Your Mileage May Vary.

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Advice from the NYT

February 16, 2025

On December 30, 2024, the New York Times offered an article: “10 Ways to Keep Your Mind Healthy” in 2025, by Christina Caron and Dana G. Smith. Now, I’m not saying that their advice was bad. I’m just saying it didn’t go far enough. All of their recommendations are things we already know. Someone with a simple need for better mental health may get something from the article. But for someone with a mental disorder, it’s inadequate. Here’s what they said.

1. Move your body.

“If you’ve heard it once, you’ve heard it 1,000 times: Physical activity is one of the best things you can do for your brain.” Well, we have heard it 1,000 times. The Times notes that people feel better after a workout, but that ones who have a consistent exercise routine, there’s less risk of depression (and dementia). They attribute this to better blood flow and connections in the brain. This is hardly revolutionary advice.

2. Address your anxiety.

Easier said than done. NYT says: “Many Americans are anxious.” They suggest the following solutions. Face what makes you anxious to break the pattern of fear. They say that you can do this kind of exposure therapy with or without a therapist.

They also recommend that you focus on your values rather than anxiety. I’m not sure how this is supposed to work. One suggestion they give is to volunteer in your community. Then they advise that you not catastrophize—but they don’t tell you how to do that, except for journaling about whether you had an appropriate amount of worry compared to the situation.

3. Challenge your brain.

The authors note that this is “still up for debate,” but they say that crossword puzzles, reading, and brain games “can’t hurt,” especially regarding dementia. The most definite thing they way is that such pursuits “can’t hurt.” A professor of psychology adds that “chances are that’s probably good for your brain.” But “good for your brain” is a long way from mentally healthy.

4. Get a good night’s sleep.

Lack of sleep “can affect how they experience stress and negative emotions. They might also be more likely to ruminate, be quicker to anger, have more negative thoughts or find it harder to cope with stress.” Those are serious symptoms, and for once, the NYT recommends actual therapy—Cognitive behavioral therapy for insomnia, or C.B.T.-I. They note that it is more effective than medication. At last, some useful information!

5. Get unstuck.

Good idea, but how to do it? According to the NYT, you should conduct a “friction audit.” which basically means identifying your problems and trimming them away, whatever that means. They also recommend “futurecasting,” or imagining you aren’t stuck and what steps would get you there. “Try to do at least one step each day.” Baby steps are good, of course, but doing one per day isn’t practical for most people with mental disorders. A therapist might help with this, but the NYT is silent regarding that possibility.

6. Stay cool.

At last, something that you may not already know! “Studies show that hot days impair our cognition and make us more aggressive, irritable and impulsive.” Typical ways of cooling off are recommended: stay cool and hydrated, use air conditioning or a fan, spritz yourself with cold water or take a cool shower, or go to a nearby cooling shelter. Nothing there but obvious remedies.

7. Quiet your inner critic.

If only we could! The inner critic is a real thing, and it makes you miserable. But the trick is how to do it. The authors suggest “letting go of that nagging feeling…and giving yourself credit credit for what you accomplish.” They do quote a psychology professor who suggests using “you” or your name rather than “I” when you engage in internal dialogue, which I take to mean affirmations.

8. Take care of your physical health.

This sounds good; the body and brain, of course, are interrelated. The NYT recommends taking a quiz about your physical health that analyzes common health conditions and behaviors such as blood pressure, cholesterol, and exercise. It’s said to estimate your risk for depression, as well as dementia and stroke. But most general practitioners these days use a specific depression screening quiz with more questions particular to that condition.

9. Make a new friend.

This is a great idea. People with mental disorders need a support system which can certainly include friends as well as family. One problem is gaining the courage and social skills to make overtures. The Times notes that loneliness can increase brain inflammation that damages brain cells and the connections between them. Then the article recommends reaching out to a friend or family member, joining a club, or attending a support group. Reaching out is difficult for people with depression in particular. Waiting for someone to reach in to you is sometimes all you can manage.

10. Forgive — or don’t!

Contradictory advice? Certainly. The Times article suggests that “forgiveness is an emotional process rather than an endpoint.” So, should you or shouldn’t you? Maybe. Forgiving someone who’s hurt you may lead to fewer negative feelings, the Times says, but they also recommend a book called You Don’t Need to Forgive: Trauma Recovery on Your Own Terms by Amanda Gregory.

I know what you’re going to say: This article is intended for the general public. It makes no mention of the many things such as therapy and medication that can help you achieve a healthy mind if you have a mental disorder. That the actions mentioned are meaningful adjuncts to those interventions.

But the title is misleading. I first got treatment for my mental health when I saw a sign for a mental health clinic and realized that whatever I was feeling, it wasn’t mentally healthy. At that point I received therapy, and later was prescribed medication. And they truly helped.

I would hate to think that someone like me would ready this article and think that the suggested actions, by themselves, will make a person mentally healthy. They are great adjuncts to proper treatment but won’t solve many problems that people with mental disorders have. If, like me, your only realization is that you don’t feel mentally healthy, the article may prevent or delay getting significant treatment.

So, go ahead. Try all the advice in this article. But if you still don’t feel you’re on an even keel, seek other kinds of help.

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We Don’t Talk About It

February 9, 2025

When I was first diagnosed with depression (later bipolar disorder), my family was somewhat less than understanding. My father was concerned that he might have to go to family counseling, with the implication that it would involve analyzing or blaming him. My mother informed me that Prozac, which I was prescribed, was “a ticking time bomb” and later said that she thought that if I got a better job, I wouldn’t be depressed anymore. And my sister was dismissive about paying someone a lot of money just so I could talk.

I admit that I did not handle this terribly well. I missed the opportunity to educate my family about these psychological conditions. (I did tell my sister that I was going to a community mental health service that had a sliding scale for payment.) In my defense, I was new to the concepts too, and had barely begun to educate myself about them. I did gradually learn more, but their initial reactions kept me from saying much about it to my family.

As stigma goes, this was pretty mild. They didn’t try to tell me there was nothing wrong with me. They didn’t blame or shame me for reaching out for therapy (other than my sister). But because of this, I didn’t receive much support from my family which would have made my journey easier. That only happened when I married a man who knew something about psychology and learned what would help and what wouldn’t.

Stigma can be a familial problem, but it also happens at a societal level. But mental health concerns are very low on the list of many legislators’ concerns and priorities. Some have denied that mental illness even exists or responded to it by clearing away the unhoused or creating sober houses. Mental illness is seen as a consequence of PTSD, which is talked about mostly in the context of veterans, seldom about other causes like abuse. Also, most of the fundraising for veterans seems to concentrate on limb loss and traumatic brain injury. If funds are going to specific mental disorders other than PTSD, it isn’t emphasized, despite the need.

A lot of what we hear about mental illness is about SMI or serious mental illness. And that often gets conflated with the problems of homelessness, addiction, and violence. But what about all the people with Major Depressive Disorder, Bipolar Disorder, Anxiety Disorders, Personality Disorders, and even Schizophrenia who live in homes and families, who have families of their own, and who have jobs? They’re very rarely talked about. They don’t get emergency funding. They don’t require street psychiatry, emergency housing, forced commitment, and other services that are needed for the most severely ill. They’re not high-profile.

They’re called “high-functioning” and then largely ignored, left to deal with their disorders on their own. Many of them miss out on the therapy, meds, and lifestyle changes that might help them, either because they don’t know where to go or don’t have the funds to access them. Insurance pays for quick fixes of 6-8 weeks, which are the merest band-aid on their problems. Supportive families, biological or chosen, can help them maintain their relationships, living situations, and jobs, but public attention isn’t focused on them in any meaningful way. There are ad campaigns that say “It’s okay not to be okay” and encourage friends to reach out, but they’re vague and short on what to do when you realize you need help. Hotlines focus on suicide and self-harm. They’re certainly needed, but so are resources for the day-to-day, less dramatic disorders.

Stigma, confusion, lack of education, ignorance, and even hostility keep us from the conversations that might lead to actual, useful change. Let’s open up those conversations with our families, friends, coworkers, the press, local and national government, and anyone else who’ll listen. Blogging and maintaining a Facebook group (Hope for Troubled Minds) are among my contributions to the effort.

I’ll keep trying if you will.

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What Was I Feeling?

February 1, 2025

It wasn’t supposed to be journaling. I thought I was writing a blog post to be called “On Happiness.” It was about the fact that, even though my bipolar disorder is well controlled, something was sucking the joy out of what should have been joyful times—our dream trip to Ireland, for example, or the fact that I just got a work assignment after a long drought. Not even a mid-winter trip to Florida lifted my spirits.

It didn’t feel like depression, though. That’s a creature I know well, and this wasn’t it. Oh, the lack of joy was the same, but there were no unexplained fits of crying or immobility. In fact, I was experiencing a flurry of activity getting ready for the Florida trip. Putting money away from every paycheck. Making sure we had enough meds for the week. Arranging boarding for the cat. Downloading directions to Google Maps. Checking the flight reservations at least twice a week. Planning what goes in the carry-ons. Juicing up my e-readers and my laptop so I could work on my new assignment and my blogs while we were away.

No, this wasn’t depression.

What it was, was anxiety. Where was this coming from?

Suddenly, I remembered. I had gotten a copy of my file when Dr. Ramirez had to prepare it for my disability application (which failed, of course). On it I read, bipolar disorder, type II, which was expected. But it also said anxiety disorder. And I forgot about that.

All these years, I’ve been concentrating on the bipolar diagnosis—keeping my moods level through a combination of meds and therapy, readjusting levels and times as needed.

But I had been ignoring my anxiety. I was taking one small dose of an anti-anxiety med, with permission to take an extra one as needed. Mostly, I just took the one at night to help me sleep. Unless I was under severe, immediate stress, I ignored the ability to take a second one. That only happened in Ireland, when we were driving on the unfamiliar side of unfamiliar roads with the first roundabouts I had ever encountered. After that, it was back to one a day at bedtime.

But then, as I was trying to write my blog post about how bad I was feeling, it occurred to me (duh) that what I was feeling was not depression, but massive anxiety. All my planning for the trip, all my worrying about our budgets and my work, were clear signs of it, even if I had somehow missed them.

By now, everything for the trip is planned, a few days early even, and my blogs are prepared to post while I’m away. I could relax. But you know I won’t, and I know it, too.

What I will do, though, is to start taking that extra anti-anxiety pill as part of my morning regimen. Unloading some of the remaining tasks like packing on my husband. And trying to distract myself by losing myself in a book.

And, of course, remembering all this for when we return and I have another appointment with my psychiatrist. Who knows? Maybe the twice-a-day pill regimen will have made a difference by then. And if it hasn’t, we can discuss it and see what else might help. (I know, I know. Breathing. Meditation. Mindfulness. Exercise. All of which are difficult for me to practice regularly. I haven’t been able to turn them into consistent habits.)

My husband helps me with my moods. I check with him when I start feeling manicky. He gives me loving attention when I start sliding into depression. He has proven that he can recognize extreme anxiety in certain unusual situations and recommend that I take that second anti-anxiety pill. What I plan to do, at least until my next med check, is not wait for that extreme anxiety to hit and work the second pill into my routine to see if it helps. And ask Dan for help in remembering to do that.

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Weed: Yes Please or No Thanks?

January 25, 2025

I know that some people swear by the benefits of marijuana for relieving their psychiatric symptoms. They find it calms their anxiety, lifts their depression, and helps them sleep. I know others who avoid it completely. It makes them dizzy and paranoid, which isn’t relaxing at all. Which group is right? Or is either side wholly right? Is marijuana a potential treatment or a potential setback? Or do both these views have their merits?

Let’s start with a look at medical cannabis. In 1850, cannabis was officially recognized as a treatment for a variety of conditions, including gout, snakebite, excessive menstrual bleeding, leprosy, rabies, and insanity, among others. It was inexpensive, widely available, and didn’t require a prescription. But its use declined because it was difficult to control the dosage, opiate-derived medications became popular, and cannabis couldn’t be administered by injection. Recreational use of cannabis was prohibited in all states, thanks in large part to scare campaigns. Fees and regulations made it less likely that doctors would prescribe it. By 1941, it was no longer considered a medical drug. Recreational use, of course, continued. By the 1970s, marijuana was prohibited in all contexts including medical, but investigation of its medical uses increased because it was reported to help cancer and AIDS patients with pain and nausea. It was also beneficial in treating glaucoma patients. State and federal laws differed, however, and in practical terms, marijuana might or might not be available legally.

By the 2000s and 2010s, many states permitted the sale of marijuana or CBD (which is not psychoactive) for medical use, including relieving seizures in children. CBD products are legal in some jurisdictions and not in others, and enforcement varies. Laws in some places are so liberal that there are legal commercial stores on many streets.

The conditions cannabis can be used for differ from state to state, and the restrictions change frequently. It’s hard to keep up with which states allow it for what conditions. PTSD is the psychiatric illness most likely to qualify for medical marijuana use. Some doctors believe that it’s also useful for anxiety, depression, Tourette’s syndrome, and anorexia. CBD and THC (the psychoactive component) are being studied for the treatment of bipolar disorder.

The medical community cautions people with psychiatric disorders about using marijuana. One study cited by the Psychiatric Times found “a strong increased risk of manic symptoms associated with cannabis … an earlier age of onset of bipolar disorder, greater overall illness severity, more rapid cycling, poorer life functioning, and poorer adherence with prescribed treatments.” On the other hand, Medical News Today has reported that users say marijuana use has reduced their anger, depression, and tension, and created higher energy levels.

Other studies have found that marijuana use had negative results on memory, decision-making, coordination, emotions, and reaction time, as well as an increased likelihood of disorientation, anxiety, and paranoia. Some reports suggest that marijuana use makes it more “likely” that psychiatric patients will develop schizophrenia and psychoses.

So, what are the takeaways? First, the results from all these studies are generally self-reported by the marijuana users and therefore subjective. Second, now that medical marijuana is in greater use and easier to get, there may be more thorough studies in the future (much of the cited studies were done 8-10 years ago, though they were still being reported as recently as 2024).

Bipolar patients have been using marijuana to alleviate both manic and depressive symptoms and report that it works better for them than conventional medications and also alleviates the side effects of those drugs. The drug’s calming effects may help with manic symptoms and the euphoric effects may explain the relief of depression reported. But heavy use has been associated with increased symptoms, thoughts of suicide, and the development of social anxiety disorder.

Perhaps the positive effects of marijuana for bipolar disorder are influenced by the expectations of the users: If they expect it to decrease anxiety or lighten their mood, it’s likely to. Still, heavy or daily use should likely be avoided because of possible negative side effects.

My own use of CBD has been confined to legal hemp-based gummies. I have found them to produce unhelpful, uncomfortable sensations, making me unbalanced and prone to falling, which I really don’t need. But that’s me, and it’s anecdotal evidence. Another person I know experiences relaxation and euphoria with no negative side effects.

To answer the question posed in the title, my personal answer is “No thanks,” but I’m not saying that should be the answer for everyone. It looks like a case of “Use at your own risk.”

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When You Can’t Tell If Dreams Are Real

January 19, 2025

When my husband has bad dreams, he has the ability to wake himself up or change the dream. At different times, Dan’s been able to realize that he wasn’t still in high school when he had the dream (the one everyone has) about being late for a test or not knowing anything about the topic. He’s dreamed about getting into a fight with someone, said to himself, “This is stupid,” and left the scenario. And he has had a dream when someone was saying, “I’m going to kill you.” He replied, “No, you’re not. I’m going to wake up now” and did. He’s a lucid dreamer.

Dreams occur during REM, or rapid eye movement, sleep, which happens around an hour and a half after you fall asleep and can last ten minutes or an hour the longer you sleep. Scientists believe that the dreams that come during REM sleep help you interpret memories or work out problems based on your experiences. That happens below the level of consciousness. You don’t usually wake up and think, “Oh! That’s what I should do about my problem!” Gradually, though, the insights gained from dreams can float to the surface and appear as if they’re new ideas.

“Lucid” dreams or dream manipulation occurs when you realize you’re dreaming and can deliberately affect the outcome. It’s not something everyone can do but many people have the ability or can learn. Some wake up immediately when they realize frightening nighttime images are just a dream. Or they may be able to alter the content of their dream or their behavior in the dream. That’s what my husband does.

Some people who dream don’t realize that’s what’s happening. They accept the dream images as reality. They could also feel trapped in the dream, believing that something or someone is threatening them and being unable to affect what happens. Those dreams can be both frightening and repetitive. Instead of being a time to work out problems, dreams become a form of torture. In particular, someone who has PTSD or a phobia can experience terrifying dreams that put them right back into dark places they’ve experienced.

Scientists and therapists are exploring lucid dreaming as a way to help with psychological difficulties that manifest as terrifying dreams. This “lucid dreaming therapy” may act as a kind of exposure therapy in which the dreamer confronts their fears gradually and learns to defeat them. For example, someone with a fear of heights or falling might practice lucid dreaming by incorporating an ability to fly into their dreams.

Journaling or meditation may also help a person develop the ability to dream lucidly since these practices involve recording dreams when you wake up or exploring your mind’s ability to go within. And lucid dreaming can be beneficial. You can experience an elevated mood after having a lucid dream.

There are still unanswered questions about lucid dreaming and how it may affect people with various mental health conditions. One of the basics of lucid dreaming therapy is to learn to tell whether it’s a dream or reality you’re experiencing. Those with schizophrenia, PTSD, bipolar mania, or forms of dissociation may have particular trouble distinguishing between dreams and reality. One technique that may be helpful is to test the reality of the experience, determining whether it’s really a dream. For example, you might try to put a finger through a solid object. If you can do this, it’s a dream; if not, it’s reality. Another technique is to read something that appears in the dream, such as a poster. If the text shifts as you view it, you’re in a dream; if it remains the same, you’re awake. Conduct these reality checks at times throughout the day and you’re more likely to remember to try them when you’re asleep.

Other people recommend a technique to encourage lucid dreaming that involves setting an alarm and then going back to sleep after waking. However, this can lead to disrupted sleep and be harmful rather than helpful, even if lucid dreams do occur because of it. You could also experience vivid, lucid nightmares and need “imagery rehearsal therapy,” a form of journaling in which you write down the dream right after it occurs, then write another scenario that resolves the fear in a more positive way and rehearse this scenario before you go back to sleep.

Should you try lucid dreaming? It can depend on what kind of psychological problems you experience. For example, it’s not clear whether lucid dreaming can relieve nightmares associated with PTSD or make them worse. There are also medications that can be beneficial for repeated nightmares, but it may make sense to try lucid dreaming as a non-drug alternative.

I’m intrigued by the idea that you can learn lucid dreaming but mine are anxiety dreams about missing a plane, and it doesn’t seem called for. I don’t have real nightmares often, which I’m glad of. and they don’t recur. But for people who are plagued by them, I hope they can learn to respond as my husband does.

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The Narcissism Trend

January 12, 2025

Gaslighting was the most recent trend in pop psych. Now it’s narcissism. I even wrote a post called “Is It Narcissism or Gaslighting?” Just recently, I’ve seen posts titled “Why Are Narcissists So Cold Hearted?” “5 Clear Signs You’ve Beaten Your Narcissist,” “Narcissists Hate These 5 Weird Tricks,” “The Narcissist’s Game of Twisted Loyalties,” and “How Narcissists Disconnect from Reality and Logic.”

So, why are gaslighting and narcissism so “popular,” at least for writers and those who have a personal experience they attribute to people with those conditions?

First, let’s acknowledge that the two conditions have certain similarities. Narcissists and gaslighters both tend to have large egos and look down on their victims. Both can be users and abusers. Both use techniques that create learned helplessness, the state in which the victim doesn’t know how to appease their partner. They both rely on intermittent reinforcement, where they go back and forth between solicitous love and breaking down their victim.

Many of the techniques they use are the same. They will isolate their intended victim from friends and family. The abuser will limit their ability to act independently by limiting their finances and outside activities such as work. They will trap their victims in a net that impairs their ability to envision a means of escape.

The difference comes with the ultimate result. The person who is abused by a narcissist gets used to the abuse. They doubt their ability to appease the narcissist—because there is no way to do it. The narcissist escalates the abuse, often from psychological and verbal abuse to physical abuse. The victim is often unable to leave because of fear of further abuse, whether to themselves, their children, or even their pets. They are chained to their abuser by believing that the abuse is evidence of love and that it’s their own fault.

The gaslighter’s specialty is making the victim doubt their own sanity. They will deny things that actually happened. They will say that their victim isn’t remembering things correctly. They will say the gaslit person is upset over nothing. They may even be blatant: “You’re crazy. You need to have your head examined.” One gaslighter I knew agreed to go to couples therapy, then made a big show of presenting his partner as the “sick” one and casting himself as a sympathetic helper.

Another difference is that narcissism is an actual psychiatric diagnosis (Narcissistic Personality Disorder), while gaslighting isn’t. Some therapists work with narcissists and their victims though, as with any personality disorder, improvement is not very likely. Gaslighting is not a “diagnosis” but rather a pattern of behavior. The victim recognizes and diagnoses themself: “I have been gaslit.”

That may be one thing that made the term “gaslighting” so popular. It didn’t require seeing a therapist to identify it, though, of course, you could well need a therapist to untangle the aftereffects.

Narcissists, however, are often “diagnosed” by the layperson. They identify someone who has hurt them in whatever way as a narcissist. Most of them don’t have access to the DSM to compare an abuser’s behavior to the actual criteria for diagnosis. Narcissism is classed in a category of personality disorders that feature “dramatic, emotional, or erratic features.” The Manual lists nine criteria for a diagnosis of Narcissistic Personality Disorder: grandiosity, fantasies, specialness, need for admiration, entitlement, exploitation, lack of empathy, envy, and arrogance, which are relatively stable over time and pervasive. The layperson may see only entitlement, exploitation, and lack of empathy, while not realizing that a narcissist’s traits also include fantasies and envy.

What the layperson identifies as a narcissist is sometimes just a garden-variety abuser or jerk who doesn’t have a personality disorder. Not all abusers are narcissists, and not all narcissists are abusers. Some narcissists do very well in life, becoming successful business leaders and prominent public figures. Their narcissistic tendencies are interpreted as positive attributes like drive or aspiration rather than entitlement or grandiosity.

So, back to the original question: Why is “narcissist” the go-to, trendy label for troublesome partners or bosses? It is possible they truly are narcissists and would be diagnosed as such by a psychiatrist. But it’s more likely that the supposed narcissist merely has the perception that they are better than their partners, whom they see as deserving bad treatment. It’s a common enough problem in society. But attributing a psychiatric diagnosis to them elevates them to a degree that ignores the harm an ordinary person with bad qualities can do.

It’s more dramatic to think that you’re the victim of a person who has NPD than to realize that you are being abused by a regular person who just doesn’t care about you and your feelings.

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